Looking Past Borders

Transnational Politics Offer Solutions for Women's Health

September 2, 2017

One of the major successes of the
global women’s movement has
been to critically examine the
division between the personal and the
political, and even to assert its nonexistence.
Women’s rights activists achieved
the recognition that violations against
women in the domestic sphere deserve
policy redress in the public sphere. By
eliminating barriers between spheres of
inquiry, women have illuminated previously
neglected avenues for policy action
to protect human rights.

The time has come to tear down yet
another wall: the intellectual and political
barriers between foreign and domestic
policy, just as women tore down those
dividing notions of the domestic and
public spheres.

A few major signs indicate that now
is the right and necessary moment to
undertake this project. First, recent political
upheavals, like the US election of
Donald Trump and the UK Brexit vote,
amply reveal the decisive role that foreign
concerns play in domestic affairs and vice
versa. While this interplay is not new, its
scale and impact in an increasingly interconnected
world is arguably at an alltime
high. Indeed, Trump’s invocation
of ‘America First’ is in part an attempt
to deny this interdependence between
‘home’ and abroad. Second, dismantling
the false barriers between these realms,
rather than simply recognizing their interplay,
can uncover urgently-needed
strategies to remedy human rights violations
that remain obscured if we assume
only the disjuncture between the foreign
and domestic realms.

Women’s rights activists are uniquely
positioned to engage in this project as
part of the ongoing feminist work of contesting
and renaming boundaries. Just as
extending the human rights framework
to the private sphere offered new strategies
for combatting domestic violence,
today, leveraging the indivisibility of
human rights helps reveal remedies that
recognize the multiplicity of women’s
identities and the ways they intersect to
shape women’s experiences of discrimination.
Finally, women’s rights activists, who
are well versed in transnational movement
building theory and practice, bring
more than past experience to this inquiry.
They have often worked across national
boundaries, leveraging their numbers
globally, while supporting and learning
from each other’s local and regional
struggles. This collaboration has had
the added effect of growing relationships
of solidarity in the face of some governments’
xenophobic and destructive
foreign policies. They can employ this
perspective to build transnational activist
strategies at the nexus of foreign and domestic
policy realms. In fact, the core issues
that we, as a global society, confront
—including the vital need to secure protections
for women’s health worldwide
—demand that we reveal and strengthen
strategies currently eclipsed by our
siloed domestic-vs-foreign thinking. An
examination of reproductive, economic,
and environmental policies as they shape
women’s health illustrates this mode of
inquiry

Reproductive Policies and Women’s
Health

We can start to uncover those transnational
activist strategies with the issue
of reproductive justice as a cornerstone
of sexual health and women’s rights. In a
US policy context, two legislative examples
restricting abortion access help show
the need to remove barriers between domestic
and foreign realms in our thinking.

The 1973 Helms Amendment to the
US Foreign Assistance Act prohibits
US funding from paying for abortions
around the world. The continuing impact
of the amendment is to underfund
women’s health programs and compel
women to seek out unsafe abortions. The
World Health Organization (WHO) estimates
that 21.6 million women have
unsafe abortions each year; 47,000 die
from it.

The Helms Amendment was created
as a direct response to the Supreme
Court’s Roe v. Wade decision that same
year. Senator Jesse Helms, who advanced
the amendment, did not limit himself
to blocking non-US women from having
abortions; he imposed that ideology
wherever opportunity allowed. Helms
was successful in using the backlash
against the domestic reproductive rights
protection of Roe v. Wade to obstruct
women’s access to abortions worldwide.
But he was just as adamant about restricting
women’s abortion access in the
United States, promulgating such measures
as a 1981 bill to give fetuses constitutional
rights.

Meanwhile, another bill, the Hyde
Amendment, took a few more years to
take shape. Passed in 1976, it prohibits
the use of federal funds from covering
abortions domestically except to save the
woman’s life or if the pregnancy results
from rape. The Hyde Amendment particularly
takes aim at Medicaid funding,
a program designed to provide health
care to low-income families. From the
perspective of the millions of women impacted
by these policies, the Helms and
Hyde Amendments reveal stark parallels:
in their disproportionate impact on
women of color and poor women, and in
their denial of women’s bodily autonomy
and reproductive choice, whether in the
United States or around the world.

Reproductive rights organizations in
the United States and internationally
have made some inroads in connecting efforts
to overturn these two amendments.
Yet, there are still untapped opportunities
to render domestic US organizing more
transnational. Often, domestically-oriented
US women’s organizations make
the understandable judgment call that
they can little afford the resources to take
on women’s crises beyond US borders.
However, advocates should consider the
possibilities that derive from transnational
collaboration, and that solutions
to their own crises may be found across
national lines.

Already, in their separated local contexts,
women are constantly and by necessity
innovating ways to overcome barriers
to their reproductive health. These
include, in the United States, the National
Network of Abortion Funds, which
pays for women’s expenses and travel
to states where they can more easily access
abortion services. In countries like
El Salvador, Brazil, and Mexico, women
share information on how to mitigate the
risks of self-induced abortions using the
WHO-recognized and over-the-counter
medication misoprostol.

As abortion restrictions tighten in local
contexts, women and their supporters
can gain new practical measures to
provide for reproductive rights through
cross-border exchanges. For example, a
Dutch organization, Women on Waves,
sends ships to drop anchor off the shores
of countries where abortion is banned or
severely restricted, and invites women to
enter international waters to receive care.
A report by Rewire shows that women in
Texas, facing the shuttering of abortion
clinics across the state, are now organizing
to share WHO guidelines on the
use of misoprostol, borrowing directly
from the experiences of women in Latin
America.
These small-scale models offer an initial
blueprint for the type of transnational
activist strategies, borrowing from local
initiatives, which can mitigate harms and
secure reproductive rights in the face of
restrictive policies.

Economic Policies and Women’s
Health

This dynamic of finding solutions by
erasing the divide between the domestic and the foreign also plays out in the
realm of economic policy, with implications
for women’s health. A conventional
view of health as a measure of medical
fitness obscures the fact that economic
forces are the primary determinant
of people’s health. Consider the consequences
of poverty, which is the root cause of most people’s poor nutrition,
lack of access to basic health care, and
lack of clean water and sanitation. Poverty
and economic inequality are also
major contributors to public health crises
such as violence, mental illness, stress,
and substance abuse. Therefore, efforts
to improve women’s health outcomes require
taking on global and domestic economic
inequality and poverty.

Economic conditions that generate
poor health were widely enforced by the
much-maligned Washington Consensus,
through which powerful financial institutions
like the World Bank and International
Monetary Fund implemented a set
of top-down economic policies throughout
much of the Global South. These
were imposed on countries in need of
development aid to remedy years of economic
exploitation by the backers of that
same Washington Consensus.

The cocktail of enforced austerity, deregulation,
and privatization was a onesize-fits-all
neoliberal recipe incorporated
into multiple US trade agreements with
countries in Latin America, Africa, and
Asia. It also found its counterpart in domestic
US economic policies, referred to
since the 1980s with monikers like ‘Reaganomics,’
‘the end of Big Government,’
and most recently, “the deconstruction of
the administrative state.”

While generally presented in technical,
macroeconomic terms without regard to gender, these policies generate
particular consequences for women,
including specific threats to women’s
health. When government-funded social
services fall under the ax of ‘fiscal
discipline,’ the safety net upholding living
standards for women and families is
torn. Care work formerly provided by
public programs, schools, and hospitals
is pushed into the informal, unpaid sector;
in the gendered division of labor,
this work becomes the responsibility of
women. Today, global statistics show that
women do more than twice the unpaid
labor of men, and in countries subjected
to neoliberal economic reforms, women’s
work burdens become even heavier.
For instance, a report by the European
Women’s Lobby showed that austerity
measures reduced access to care services
across the region, with public kindergartens
closing in Greece and Portugal, with
30,000 children turned away from preschools
in the Czech Republic, and with
Ireland slashing the number of beds in
nursing homes. This displaced care work
becomes women’s responsibility, with
corresponding impacts on women’s economic
independence and employment
rates.

In essence, women are expected to
care for those who can no longer afford
health care, largely due to the assumption
that women’s unpaid labor is limitless
and cost-free. It is neither. While
attempts are sometimes made to place a
dollar value on that unpaid labor (a 2015
McKinsey report sets the figure at US$10
trillion per year), another vital measure
would be found in the health impacts of
women’s overwork, including physical
and psychological stress.

Harsh austerity policies also have direct
negative impacts on women’s health.
During the worst days of Greece’s economic
crisis, health researchers warned
about the decline in maternity care as a
result of steep budget cuts, resulting in an
increase in the rate of stillbirths. In the
early days of the Trump administration,
initial reports reveal that the new administration
is considering the elimination
of programs meant to combat violence
against women, as part of sweeping cuts
in their ‘blueprint’ budget. Given that
the US Centers for Disease Control and
Prevention estimates that 1 in 3 women
will face intimate partner violence in her
lifetime, violence against women remains
one of the most prevalent and deadly
threats to women’s health today.

Like austerity measures, wage suppression,
another staple of neoliberalism in
US foreign and domestic policy, has severe
impacts on women’s health. In 2011,
State Department cables released by
WikiLeaks revealed the extent to which
the US government intervened in Haiti’s
minimum wage struggle. The US Embassy
and the US Agency for International
Development pushed misleading data
about the impacts of a wage increase as
part of a vigorous fight against a widely
popular proposal that would raise Haiti’s
minimum wage to a paltry US$5 per
day. The cables showed that, in an effort
to support brand name companies like
Levi’s, Hanes, and Fruit of the Loom,
which opposed the increase, Washington
also closely monitored pro-wage increase
protests, and UN troops were used to
tamp down student mobilizations. These
back channel efforts to suppress wages
have particular effects on women, especially
in sectors where they are overrepresented,
like the garment industry.

Meanwhile, in the United States, the government has used taxpayer resources
on behalf of large corporations in efforts
to undermine social movements advocating
for economic equality. For example, a
Freedom of Information Act request by
the Partnership for Civil Justice Fund revealed
that the Federal Bureau of Investigation
(FBI) and other intelligence and
police agencies monitored the Occupy
Wall Street movement under the guise
of combatting terrorism, while simultaneously
holding secret meetings with the
New York Stock Exchange. Of course,
much of the opposition has happened in
plain sight: the US-based workers’ campaign
known as Fight for $15, to raise
minimum wages to US$15 per hour, has
faced legislative blocks by lawmakers
across the country. According to a 2014
report by the US Bureau of Labor Statistics,
women make up more than 61 percent
of people with wages at or less than
minimum wage, signifying that women
and women’s health are disproportionately
impacted by political attempts to
suppress wages.

In response to the opposition they
faced, US organizers of the Fight for $15
put out a call for support. They found
that allies not only within the United
States but from 33 countries rallied to
the cause, and non-US supporters staged
solidarity rallies when US workers went
on strike. While the victories in this minimum
wage struggle will necessarily be
implemented at the local and domestic
level, transnational activism helps mobilize
new and larger constituencies for
policy change.

Climate Policies and Women’s
Health

Just as the women’s health impacts of
economic policies are often overlooked,
climate change continues to be treated
primarily as a technical or scientific
problem. In fact, its impact on women’s
health, especially for the world’s poorest
women, is severe and disproportionate. As
the Intergovernmental Panel on Climate
Change (IPCC) points out, “[people]
who are socially, economically, culturally,
politically, institutionally, or otherwise
marginalized are especially vulnerable to
climate change.” The IPCC underscores
the inequities that drive greater climate
vulnerability, and result from intersecting
“discrimination on the basis of gender,
class, ethnicity, age and (dis)ability.”
Indeed, women in poor countries are
more likely to die during climate catastrophes
like flooding and hurricanes
than men are.

Moreover, their lack of
legal assets, property, and rights leaves
them less equipped to rebuild and more
vulnerable to gender-based violence and
other harms that further the cycle of poverty
and ill health.
Moreover, women’s day-to-day unpaid
work of feeding and caring for families
and communities becomes harder and
absorbs more time as a result of climate
change, compounding the negative impacts
of economic policies. For instance,
when drought makes water scarcer, women
and girls tasked with seeking out dwindling
supplies must carry heavy loads
over greater distances and lose valuable
hours for activities that correlate with improved
health outcomes, including education,
paid work, and leisure.

In drought-stricken areas of Kenya,
women have documented how climate
change intersects with gender discrimination
to produce specific threats to
women’s health. As livelihoods are destroyed
by the drought, parents desperate
to feed their families increasingly pull
their daughters out of school and into
early marriage in exchange for a dowry.
Early marriage, in turn, is linked to two
of the greatest threats to women’s health
in this region: female genital mutilation
and maternal mortality.

The world’s poorest people, including
women, bear both the greatest health
impacts of climate change and the least
responsibility for causing it. For example,
the abovementioned protracted drought
in Kenya is exacerbated by greenhouse
gas emissions generated thousands of
miles away. At root, climate-related
threats to women’s health in communities
worldwide emerge from a classic
tragedy of the global commons. When
powerful countries and companies exploit
finite natural resources and pollute
our shared environment, the impacts are
not constrained to national boundaries.

This dynamic renders the utility of
dividing environmental policy into categories
of ‘foreign’ and ‘domestic’ particularly
limited. As with reproductive health
and economic policy, the transnational
impetus and impacts of environmental
policies invite women’s health and rights
advocates to organize across political
boundaries for the greatest impact. In
fact, the outpouring of solidarity with
the women water protectors of Standing
Rock from women climate justice
activists worldwide is predicated on the
understanding that a fight to stop fossil
fuel extraction or a pipeline in one corner
of the world has ramifications across the
globe.

Women climate activists further recognize
that while the causes of climate
chaos are transnational, health impacts
are experienced locally, necessitating that
women’s political organizing span the
local and global and focus on the interplay
between these realms. At the local
level, grassroots women climate defenders
are creating rain harvesting methods
to conserve water, setting up seedbanks
and greenhouses, sharing adaptive farming
techniques, and more. By building
their communities’ resilience to climate
change impacts, these women help secure
better health outcomes, from reducing
the incidence of waterborne diseases
and child marriage to improving overall
food security.

Transnational exchanges enable women
in diverse local contexts to share and
adapt ideas to strengthen climate change
adaptation strategies. For instance, indigenous
women in Nicaragua have
borrowed and replicated rainwater harvesting
techniques established by women
in Kenya, after participating in an
exchange as part of my organization’s partner network.

Such tested approaches offer a blueprint
for policymaking far beyond the
local level. When indigenous women in
Kenya set up clean water and rain harvesting
systems, protecting people from
waterborne illness and freeing women
from the time-intensive labor of water-fetching,
these community-based
interventions present models that can
be replicated, adapted, and scaled-up
through national and international policy
frameworks. Yet, despite the adaptive
solutions being innovated by grassroots
women, these actors are routinely and
systematically excluded from meaningful
participation in environmental policy
and planning efforts.

Women’s health and rights advocates’
ability to impact policymaking spaces is
bolstered by their transnational collaboration,
as they reach out across borders to
share their expertise, evidence, advocacy
strategies, and climate policy solutions.
A transnational perspective further understands
that there are multiple points
of entry for advocates to influence climate
change policy globally, including
by offering a much-needed framing of
climate change as a public health issue
with particular gendered impacts. That
is why women climate activists at the
Kenya-based Indigenous Information
Network devote their energies both to local
lobbying to ensure that county-level
budgets support women’s efforts to build
community health and resilience to climate
change, and also to convening with
other indigenous climate activists around
official UN climate negotiations like the
2015 Paris Conference. By gathering
with other activists grappling with similar
challenges, local activists deepen their
understanding of their own context and
consolidate shared strategies for influence,
especially when they face exclusion.
In this way, they are further empowered
to play key roles in addressing climate
change and its many threats to public
health.

Conclusion

To tackle as holistic and global an issue
as women’s health, countless realms of
life are implicated and drawing dividing
lines is not only difficult, it is ill-advised.
Examining these three areas—reproductive,
economic, and environmental policies—reveals
that not only does each set
of policies have impacts on global women’s
health, they traverse national boundaries
as well. To better equip themselves
to advance women’s health and rights,
activists must be ready to work across
these permeable boundaries, forging new
alliances and activating transnational
strategies to confront root causes.

This is an enduring principle, but it is
sorely tested by the times we live in. Heads
of state like Donald Trump, by espousing
rhetoric and enacting policies based
on a ‘clash of civilizations’ worldview,
attempt to pit the one side—the United
States and the Western world—against
enemies portrayed as so-called ‘radical
Islamic terrorism’ or ‘illegal’ immigrants.
As is typical of ‘us vs. them’ binaries
throughout history, this manufactured
clash invokes women’s bodies and identities
to reinforce political and nationalist
categories and to trigger fear and anxiety
about infiltration by the ‘Other.’ Consider
the pejorative terminology of ‘anchor
babies’ used in the United States to cast
suspicion on undocumented mothers, or
the recurring attempts in certain European
countries to regulate the clothing of
Muslim women by banning hijabs and
other religious coverings.

Such policies seek to re-inscribe the
boundaries between foreign and domestic
by rooting out the ‘Other’ within the
‘homeland,’ with negative consequences
for women’s health and human rights.
For example, undocumented women
who fear deportation or Muslim women
who face hostility and Islamophobia
will encounter barriers to accessing their
right to respectful, high-quality health
care and to recourse from gender-based
violence—rights recognized under international
law.

The prescription of transnational
collaboration and activism carries
new urgency in this moment. Women’s
rights activists must not make the mistake
of inadvertently reinforcing the inward-facing
posture of ‘America First.’
Now is the time to reach out across the
borders—physical and conceptual—that
opponents of human rights, including
women’s rights to health, are seeking to
fortify